학술논문
Splanchnic vein thrombosis in myeloproliferative neoplasms : Risk factors for recurrences in a cohort of 181 patients
Document Type
Author
De Stefano, V.; Vannucchi, A. M.; Ruggeri, M.; Cervantes, F.; Alvarez-Larrán, A.; Iurlo, A.; Randi, M. L.; Pieri, L.; Rossi, E.; Guglielmelli, P.; Betti, S.; Elli, E.; Finazzi, M. C.; Finazzi, G.; Zetterberg, E.; Vianelli, N.; Gaidano, G.; Nichele, I.; Cattaneo, D.; Palova, M.; Ellis, M. H.; Cacciola, E.; Tieghi, A.; Hernandez-Boluda, J. C.; Pungolino, E.; Specchia, G.; Rapezzi, D.; Forcina, A.; Musolino, C.; Carobbio, A.; Griesshammer, M.; Barbui, T.
Source
Blood Cancer Journal. 6(11)
Subject
Language
English
ISSN
2044-5385
Abstract
We retrospectively studied 181 patients with polycythaemia vera (n=67), essential thrombocythaemia (n=67) or primary myelofibrosis (n=47), who presented a first episode of splanchnic vein thrombosis (SVT). Budd-Chiari syndrome (BCS) and portal vein thrombosis were diagnosed in 31 (17.1%) and 109 (60.3%) patients, respectively; isolated thrombosis of the mesenteric or splenic veins was detected in 18 and 23 cases, respectively. After this index event, the patients were followed for 735 patient years (pt-years) and experienced 31 recurrences corresponding to an incidence rate of 4.2 per 100 pt-years. Factors associated with a significantly higher risk of recurrence were BCS (hazard ratio (HR): 3.03), history of previous thrombosis (HR: 3.62), splenomegaly (HR: 2.66) and leukocytosis (HR: 2.8). Vitamin K-antagonists (VKA) were prescribed in 85% of patients and the recurrence rate was 3.9 per 100 pt-years, whereas in the small fraction (15%) not receiving VKA more recurrences (7.2 per 100 pt-years) were reported. Intracranial and extracranial major bleeding was recorded mainly in patients on VKA and the corresponding rate was 2.0 per 100 pt-years. In conclusion, despite anticoagulation treatment, the recurrence rate after SVT in myeloproliferative neoplasms is high and suggests the exploration of new avenues of secondary prophylaxis with new antithrombotic drugs and JAK-2 inhibitors.